Motor vehicle collision rates have been shown to fall approximately by half for elderly drivers after cataract surgery. Currently, most insurers allow payment for cataract surgery based upon an individual's self-reported visual difficulties or adverse visual symptoms. As a consequence, surgery tends to occur some time after significant vision problems have emerged. Using data from the Impact of Cataracts on Mobility (ICOM) study and related databases, simulation modeling will be used to examine how many motor vehicle collisions and deaths might be avoided if a threshold measure of vision, contrast sensitivity, were to determine when cataract surgery ought to be performed. The cost effectiveness of such earlier cataract surgery will be examined. A draft guideline will be developed for determining when to perform cataract surgery so as to reduce motor vehicle crashes. This draft guideline will be circulated to professional societies and other stakeholders for their comments, and the simulation model will be rerun to determine the cost effectiveness of any recommended changes. Specific aims of this project are the following: Aim 1: To determine how many motor vehicle collisions would be avoided in the U.S. if threshold vision measurements such as contrast sensitivity were used to determine when cataract surgery ought to be performed; Aim 2: To determine the societal cost effectiveness of earlier cataract surgery compared to current practice;and Aim 3: To develop a draft guideline for cataract surgery that is based upon both patient self-reported visual difficulties and threshold vision measurements. PUBLIC HEALTH RELEVANCE: Motor vehicle collision rates have been shown to fall approximately by half for elderly drivers after cataract surgery. Currently, most insurers allow payment for cataract surgery based upon an individual's self-reported visual difficulties or adverse visual symptoms so that, as a consequence, surgery tends to occur some time after significant vision problems have emerged. Simulation modeling will be used to examine how many motor vehicle collisions and deaths might be avoided if a threshold measure of vision, contrast sensitivity, were used to determine when cataract surgery ought to be performed, and a draft guideline for earlier cataract surgery based on model findings will be developed and circulated for comment.